Based on MSF’s work in Liberia, Burundi, the Democratic Republic of Congo (DRC), South Africa, Colombia, and other countries, the report, titled “Shattered Lives,” highlights the need for emergency medical care to be made available to people who have been raped. MSF also stresses that such services need to be truly accessible, with guarantees for confidentiality and an offer of comprehensive care.

“In 2007, our teams treated well over 12,000 victims of sexual assault worldwide, in both conflict settings and stable environments,” said Meinie Nicolai, MSF operational director in Brussels. “That is about 35 people every day, in MSF projects alone. Each tells a story of horror, pain and degradation, often inflicted by the very people who should provide protection, such as fathers, uncles, neighbors, or soldiers. And all of the victims are at risk from serious long-term health consequences as a result of the assault,” she said.

Post-exposure prophylaxis to prevent HIV-infection is crucial in the offer of medical care; the course of medication needs to be initiated as quickly as possible, and definitely within 72 hours, in order to be effective. Treatment for other sexually transmitted infections, such as Hepatitis-B, must also be included. For those physically injured during assaults, tetanus injections are required. Emergency contraception is possible up to five days after forced intercourse, to prevent unwanted pregnancy.

“We find that the specific emergency care needed for victims of rape is either very rare or completely absent in the countries where we operate,” said Thilde Knudsen, MSF’s sexual and reproductive health advisor. “The damage cannot be completely undone; some level of psychological impact is likely to remain for life. But with the right package of timely medical care, coupled with trauma counseling and social and legal support, the damage can be limited and the victim helped to survive.”

Caring for victims of sexual violence requires a specific approach from a variety of different actors. A coordinated response between organizations involved in medical, legal, and social support is the best way to bring relief to those who experience the trauma of rape and other sexual violence.

One of the difficulties MSF describes is ensuring that people come forward for care, and that they do so quickly enough. Integrating medical services for victims of sexual violence in general health care can help guarantee confidentiality. But even then, often an aggressive campaign for awareness-raising is needed for breaking through social taboos and advertising the health services.

The report includes a chapter on male victims. Men and boys make up a small minority of the people seen by MSF in its sexual violence projects (around six percent in the projects in Khayelitsha, South Africa, and Masisi, DRC). The taboos for seeking help are usually even greater for them than they are already for women and girls. Generally boys and men go unrecognized and untreated.

“This report stems from our urgent desire to share our experiences with health workers and aid agencies worldwide, for the benefit of all victims of sexual violence,” said Meinie Nicolai. “But the report is equally based on outrage. Our teams hear painful stories of horrible abuse every day. We feel compelled to speak about this. There can be no excuse for sexual violence, no matter how prevalent these violations may be in some of the places where we work.”